Percutaneous screw fixation combined with cement augmentation for sacral insufficiency fractures: bicentric study

To evaluate the functional outcomes after percutaneous screw fixation combined with cement augmentation in patients with osteoporotic sacral insufficiency fractures.

In this bicentric retrospective study, elderly patients with sacral insufficiency fractures were treated using percutaneous screw fixation with cement augmentation. Functional mobility was assessed using a 6-point scale at baseline, Day 1, 6 weeks, and 6 months. Secondary outcomes included pain scores, hospital stay, and complications. Functional and pain score evolutions were analyzed using linear mixed-effects models. Subgroup analyses explored interaction effects with fracture characteristics.

Sixty-eight patients were included. Functional scores increased from an estimated marginal mean of 2.43 (95% CI, 2.00-2.86) at baseline to 3.51 (3.05-3.97) on Day 1, 4.15 (3.69-4.61) at 6 weeks, and 4.06 (3.31-4.81) at 6 months (all p < 0.001). Pain scores decreased from 6.60 (6.11-7.10) at baseline to 2.48 (1.96-3.01) on Day 1, 1.15 (0.62-1.67) at 6 weeks, and 1.10 (0.27-1.92) at 6 months (all p < 0.001). Same-day discharge was achieved in 43% of patients. Three complications occurred (4.4%): one asymptomatic cement leakage and two grade 3 events, including one delayed hemorrhage and one screw loosening, both of which were managed without lasting effects. Functional gains varied by fracture pattern, with a statistically significant interaction observed in patients with associated obturator ring fractures (interaction p = 0.003).

Percutaneous screw fixation with cement augmentation provides early and sustained improvement in both function and pain in elderly patients with osteoporotic sacral insufficiency fractures, with a low complication rate and potential for outpatient management.

Question The clinical effectiveness of percutaneous screw fixation with cement augmentation remains to be further characterized in osteoporotic sacral insufficiency fractures. Findings Functional and pain scores improved significantly from Day 1 to 6 months, with a low complication rate and 43% of patients managed as outpatients. Clinical relevance Facilitating rapid discharge and symptom relief, this strategy aligns with the goals of geriatric care by minimizing hospitalization and promoting early functional recovery.